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Biomedical subjects

G Martius

Publications and source records attributed to G Martius.

At least 19 recordsLinked to original sources
PubMed1995

[Legal problems in obstetrics. On the "liability of the expert witness"].

There has been a depressing increase in claims for damages and associated civil code and legal code proceedings in medicine in general (as the term "defensive medicine" illustrates) that exercises considerable influence on medical activities in obstetrics, not always to the benefit of the patients. In what manner and to what extent the expert can and must influence legal decisions, is demonstrated by means of a few examples such as management of parturition in case of breech presentation, causal assessment of psychomotoric retardation in postnatal life and the management of dystocia in shoulder presentation. If judges and attorneys are blamed-as is often the case-one should always also consider the significance of expertising activities. Typical errors occurring during expert assessment are pointed out. This shows the high degree of responsibility that has to be shouldered by the expert when he advises judges and/or attorneys. Expertising activities should be directed to a greater measure than in recent years, at delivering expertises restricted to the factual situation without involving emotions. This would at the same time reduce the influence of judges, attorneys and lawyers on our medical activities, an influence that has recently been much deplored.

Birth Weight↗
PubMed1990

[Fatal outcome in HELLP syndrome].

The patient was a 32-year-old para 2 who developed within a few hours after the first symptoms a lethal HELLP-syndrome. Despite initially normal blood pressure an hepatic failure, hemolysis and cerebral bleeding appeared. The autopsy revealed an eclamptic liver and symptoms of a disseminated intravasal coagulation (DIC). As a consequence a quick delivery instead of a conservative-expectant management because of fetal prematurity is recommended.

Adult↗
PubMed1987

[External over-rotation of the head in the treatment of high longitudinal shoulder position].

The shoulder dystocias are an anomaly of shoulder presentation which render difficult or prevent complete extraction of the trunk following birth of the head. Acute hypoxia ensues, threatening the infant's life. Additionally, termination of delivery, which must be effected without delay and is surgically difficult, is frequently associated with often permanent damage to the upper limbs. Macrosomatia of the child and a vaginal-surgical delivery initiated before the preceding part has reached the pelvic floor increase the probability of high longitudinal shoulder position occurring. Early and forced application of Kristeller's method also encourages manifestation of the condition and simultaneous wedging of the shoulders in the pelvic inlet. Taking into account the inadequate shoulder rotation above the pelvic inlet, "external over-rotation of the head" is recommended as a treatment for high longitudinal shoulder position. The technique is described in detail. As soon as the condition appears likely to occur, the head is grasped in the hands (applied flat) and turned, in first position with the back of the head toward the right, in second position with the back of the head toward the left. This must be done early, i.e., if possible before the shoulders are finally locked in the pelvic inlet. Further expression of the trunk must not be assisted by Kristeller's method until high transverse position of the shoulders has been achieved. Clinicosurgical experience gathered so far and the early morbidity of the 24 children in whom high longitudinal shoulder position was overcome in this way justify the recommendation of "external over-rotation of the head" as an effective primary treatment method.

Birth Injuries↗
PubMed1981

[Study on pre-operative information on the medical aspects and prospects of a suggested operation, to be given by the gynaecologist to his woman patients].

Legislation prescribes the doctor's obligation to inform the patient of his situation and prospects before performing an operation. This obligation is of a mandatory character, the only exception being that the patient's life and health should not be seriously jeopardized by such information. The present study was based on questioning 100 woman patients, and it is evident therefrom that such an obligation places too much of a burden on the patient who is unable to cope with the information the doctor is compelled to give. In fact, our results show that frequently patients wish not only to be informed in a factual manner but also expect and desire an optimistic approach to be mediated by the doctor. Hence it appears important to pass on relevant information to the patient in a manner adapted to his personality traits and character. The article demonstrates a model for pre-operative information of this kind to be given to gynaecological patients, and it is shown how justified it is if the doctor demands a wider scope for using his own discretion and judgment in his talks with patients in respect of the information to be given to the patients. Information given by a doctor mainly with the object in mind to legally protect himself against any possible legal consequences, cannot be reconciled with the predominantly altruistic goals of the medical profession.

Adult↗
PubMed1981

[The importance of the long pelvis in clinical practice and medical education (author's transl)].

The importance of the long pelvis with lumbo-sacral assimilation in obstetrics is evaluated. 111 x-rays of the pelvis in cases with abnormal deliveries were evaluated and compared to the clinical data. The incidence of the long pelvis was not increased in the total group, nor in the 100 cases with abnormal deliveries. A long pelvis was present in 30.2% of the 43 breech presentations. In 4 cases with a funnel pelvis vaginal delivery occurred without difficulty. In 42 posterior vertex presentation the long pelvis appears to have a pathogenetic importance regarding the primary posterior position. The further course of the delivery was not influenced by the long pelvis. In 7 cases of low transverse arrest, 4 had a long pelvis but only 1 had a funnel pelvis to explain this abnormal position. In summary, the long pelvis even in its most severe form, the funnel pelvis, does not block the adaptation processes in the lesser pelvis. The changes in the pelvic inlet due to the lumbo-sacral assimilation have an etiologic importance on the initial presentation at the inlet such as breech presentation, military vertex presentation, brow presentation, or Roederers anomaly. However, no prognostic value for the mechanism of the delivery can be derived from the initial presentation. The delivery dose not depend on the long pelvis but on the malpresentation when delivery becomes necessary.

Breech Presentation↗
PubMed1980

[Pregnancies after ineffective interruption or intrauterine procedure in early pregnancy (author's transl)].

We report about 13 pregnancies after intra-uterine procedure in early pregnancy. In 12 cases infant and placenta were without any lesions. One infant had a traumatic loss of the left arm and shoulder caused by the ineffective interruption of pregnancy. Into discussion come the conditions in which we can support the wish to carry on pregnancy after an early intra-uterine procedure.

Abortion, Spontaneous↗
PubMed1976

[Termination of pregnancy and perinatal mortality (author's transl)].

Elective induction was practised in 1875 of 10 537 deliveries (17.8%). Duration of delivery was, if anything, shortened after elective induction, compared with spontaneous delivery. There was no evidence of soft-tissue dystocias after elective induction. The Apgar score was 8-10 in 95.7% of children born after elective induction. pH of umbilical-artery blood in 95.7% of children after elective induction was greater than or equal to 7.2. There was a striking increase in the incidence of occiput posterior position with elective induction (2.7% of cases). The incidence of operative vaginal delivery was as frequent after elective as after all other forms of delivery. The incidence of section was 4.7% after elective induction, 11.5% in the entire series, intra-uterine asphyxia being an indication in 1.7%, compared with 2.5% for the total group. The frequency of operations was inversely proportional to the cervical index. Perinatal mortality was 0.53 per thousand (one case) after elective induction, 10.15 per thousand in the total group, 5.9 per thousand in those with indication for early induction. Perinatal mortality decreased from 23.0 per thousand to 7.2 per thousand from 1967 to 1974.

Apgar Score↗
PubMed1975

[Experimental investigation of the effects of estriol on menopausal symptoms (author's transl)].

The mechanical writing scales are micromotor method of investigation of psychomotor discoordination capable of producing objective records of menopausal symptoms. With this method, the therapeutic effect of estriol on the menopausal symptoms can be recorded. Changes in the micromotor symptoms such as reduction in the time of writing, a decrease in the unphysiologically high writing pressure and a decrease of in inhibition and relaxation symptoms show clearly that estriol enhances a co-ordination of the motor processes of writing. The positive effects of estriol on the psychomotor co-ordination are demonstrated in the improvement of the menopausal symptoms and the improvement of the vaginal cytology. Uterine bleeding is absent since estriol has a low endometriopic action.

Climacteric↗